Now that Canada’s new clinical guidelines on treating perinatal mental health have been published, it is time for an accompanying national strategy to ensure their full implementation – something that must be prioritized by Canada’s next government.
Produced by a team of psychiatrists and other health professionals, the guidelines offer comprehensive guidance in how to prevent and treat mood, anxiety and related disorders (PMADs) during pregnancy and up to a year postpartum, including more severe conditions such as postpartum psychosis. Perinatal mental health conditions impact between 20-25 per cent of pregnant people, or 87,500-105,000 Canadians a year, making it the most common pregnancy complication. However, these conditions are also under-diagnosed, meaning that the numbers could be higher.
PMADs are “common, pervasive, and often overlooked.” They can affect both those who give birth as well as partners and support people. Studies have shown, for example, that 8-10 per cent of men can experience depression in the perinatal period.
Left untreated, perinatal mental health conditions can have devastating impacts on individuals and families, alongside wider impacts on society and the economy. A leading cause of pregnancy-related death in high-income countries is, in fact, mental health conditions. One U.K.-based study has estimated the economic cost of PMADs “at a total long-term cost to society of about £8.1 billion for each one-year cohort of births.”
A huge amount of work went into making the guidelines, released by the Canadian Network for Mood and Anxiety Treatments (CANMAT), a reality, including tireless advocacy from mothers who experienced PMADs.
However, as the guidelines make clear, “interventions are effective only if they are accessible.” It is estimated that only about 15 per cent of women with PMADs access treatment. Only 25 per cent of postpartum depression cases are identified by health-care professionals, and that number is even less for other types of PMADs.
Research is still emerging on barriers to access. A 2022 study noted that although there have been improvements over time, there are still “gaps in perinatal mental health training, screening and service provision, especially for diverse and often-marginalized groups.” The main challenge identified by professionals is long wait times (80.9 per cent), followed by financial concerns (31.2 per cent) and lack of culturally relevant services (30.7 per cent) for groups such as Indigenous parents who face additional challenges compounded by structural barriers and racism. This study noted that only 27 per cent of health-care professionals reported that therapy was available within one month. Much more common was between one to six months (67.3 per cent of respondents).
Access also differs by province. Only six provinces/territories have a policy or strategy for perinatal mental health. Screening is also fragmented; seven provinces/territories recommend universal screening, while six have specialty clinical services available. The overall picture, then, is that there are “significant gaps and inconsistencies in resources, leading to inequitable access to care across the country.”
Perinatal mental health was in fact a named policy priority for former Prime Minister Justin Trudeau: “ensur[ing] timely access to perinatal mental health services” was a commitment in his 2021 mandate letter to then-Minister of Mental Health and Addictions Carolyn Bennett. In 2023, funding was allocated to develop the guidelines. While this was a big step forward, there is much more to do.
The guidelines will be most effective with an accompanying national strategy to ensure their full implementation. In 2021, partially in response to the increase in perinatal mental health challenges during the COVID-19 pandemic, NDP MP Don Davies tabled a private member’s bill in the House of Commons calling for, among other things, universal access to mental health screening in pregnancy and postpartum; timely access to specialist perinatal mental health care services; improved training for health-care professionals; improved access to mental health care; and combating stigma.
Unfortunately, the bill died when a federal election was called in August 2021. But the need to implement what the bill called for remains.
A new strategy is needed to expand access, improve training, ensure timely care and combat the current fragmented, siloed approach to perinatal care in general. Additionally, we also know that specialized services are recommended for certain groups that might face additional challenges due discrimination, such as LGBTQ2S+ parents.
Having a child is a hugely stressful experience in general – so much so that last year, former U.S. Surgeon General Vivek H. Murthy issued a health warning about parenting. Experiencing PMADs on top of the “regular” stress parenting comes with its own additional challenges.
All of this is magnified by the shame and stigma around PMADs, partially due to the fear of being seen as a “bad parent” and the “idealized societal norms” of motherhood and parenthood. Indeed, a 2023 review article on barriers to perinatal mental health care argued that the most difficult challenge is “facilitating a societal shift in understanding and normalizing mental health challenges, needs and effective supports.”
Perinatal mental health should remain a political priority for the next government. There is “substantial urgency” to act so that people at risk of, or experiencing, PMADs can get the support and care they need.
